Faith-Based Plans
Dear Friends,
With health care options continually changing in this country, and members of our community trying to find new ways to cut their medical costs, we thought it would be important to take a look at one option that has been getting more press recently: faith-based plans.
What is a Faith-Based Plan?
These plans are not insurance; rather, they are what’s known as “medical cost-sharing”. In this system, a group of like-minded people come together to pay each other’s medical expenses. There are currently six major faith-based plans and over 100 smaller ones, the majority organized by local churches.
Who can join?
Many of these plans require regular church attendance, and some require signing off on religious statements which include Christian lifestyle allegiances. You can be denied admittance to the group if you do not meet their requirements and have a pre-existing condition.
What is covered?
Because these plans are not considered insurance, they are not required to cover the 10 Essential Benefits mandated by the Affordable Care Act, so coverage varies greatly depending on the plan. Only two out of the six major plans we reviewed covered preventive care such as physicals (“well visits”) and immunizations. Most plans do not cover conditions resulting from high risk behavior, fertility treatments, abortion, mental health care, dental services, vision or medications. It’s also common practice for members to pray with patients for their healing over the phone, individually or through call centers.
How much do Faith-Based Plans cost?
Of the six major plans we reviewed, most charge an annual enrollment fee of approximately $135, and monthly “sharing fees” of between $45 and $500, depending on the size of the family. The “sharing fee” is similar to a premium.
There are also costs that are not shared and are the member’s responsibility alone. These are similar to the deductibles and co-insurance you find in traditional insurance plans, and can range anywhere from $500 to $10,000 annually.
In addition, there are caps on what the plan will pay per year and per incident. For example, a hospital visit may cost $5,000, and the plan pays up to only $2,000 per hospital visit. The member would then be responsible for the remaining $3,000 in charges.
How are claims paid?
When someone has a medical claim, it is submitted to the organization and (if approved) is paid for by the pooled money of the group. Out of the six companies we reviewed, two reimbursed the providers directly, and the other four reimbursed the member. Three companies said they negotiate lower rates with providers. Note: Four of the six companies required pre-authorization of services in order for claims to be paid.
If you are considering one of these plans
Be aware that faith-based plans have little government oversight. The National Association of Insurance Commissioners, which sets industry standards and regulations nationwide, does not monitor any of these plans. These plans are also not required to be solvent or have reserve funds.
Thirty states have instituted laws that differentiate between health sharing ministries and insurance companies. This means that state insurance regulators are prevented from enforcing strict consumer-protection regulations against faith-based plans. While the ministries are not banned in the other 20 states, there is hope that future laws may create plan oversight in those states.
Bottom line: read the contract carefully and ask questions.
Important questions to ask before you join
What are the membership costs and the monthly costs? What would my cost be per incident? For example, how much would I pay out of pocket if I need knee surgery? What are the maximum payments the plan will pay per incident and per year?
How are eligible services determined, and who determines them? Are preventive services such as physicals, mammograms, pap smears, prostate exams and colonoscopies covered? What services are not covered?
Who do I go to if I need medical care? Is there a physician network? Are pre-authorizations required for care?
Will I be able to access health services anywhere in the country?
Are there any religious requirements?
If you are considering one of these plans, please contact The Actors Fund’s Artists Health Insurance Resource Center at 917.281.5975,for assistance in reviewing the plan with you before you purchase it, to make sure that it addresses your needs. For more information on these plans, visit this PBS article.
Yours in good health,
Janet Pearl
Senior Health Benefits Specialist
Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.
New York City
917.281.5975
Los Angeles
855.491.3357
Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit actorsfund.org/HealthServices. You can also find out more about enrollment assistance and upcoming health insurance seminars near you!